腹腔镜和显微外科治疗成年男性精索静脉曲张疗效的Meta分析

发布时间：2018-03-21 20:37

本文选题：精索静脉曲张　切入点：显微外科　出处：《中南大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的系统评价腹腔镜和显微外科治疗精索静脉曲张的疗效安全性,为临床医生选择安全有效的术式提供循证依据。方法采用电子与手工检索相结合的办法,先相关文献进行初检,进行电子检索的数据库有Pubmed/Medline database(1995.1-2012.10)、OVID(1995.1-2012.10) EMBASE(1995.1-2012.10)、中国生物医学数据库(CBM,1995.1-2012.10)相关期刊论文(CNKI:1995.1-2012.10)、中国循证医学/Cochrane中心数据库(CEBM\CCD)、Cochrane图书馆；手工检索最新发表的相关杂志文献,并通过各种主流搜索引擎查找与研究相关文献。收集所有关于手术治疗精索静脉曲张的、且是随机对照试验(RCTs)的相关研究文献。对所有文献进行严格的初步筛选,对选出的文献获取全文,并采用Cochrane协作网推荐的偏倚风险评价工具对试验进行评价。文献数据由两名研究者独立提取,采用RevMan5.1软件进行Meta分析。结果通过初选和排除后,最终有5个RCTs符合纳入标准,病例数共为554例。Meta分析结果示： (1)在5个研究中有3个试验提取到腹腔镜和显微外科治疗精索静脉曲张术后精子数量提高的相关数据,经RevMan5.1软件统计分析合并数据后得WMD=4.28,95%CI=(4.16,6.99),P0.00001,Z=7.72,认为腹腔镜手术治疗精索静脉曲张在手术时间上要比显微手术短。 (2)在5个研究中有3个试验提取到腹腔镜和显微外科治疗精索静脉曲张住院时间的相关数据,经RevMan5.1软件统计分析合并数据后得WMD=0.24,95%CI=(0.44,0.93),P=0.49,Z=0.69,认为两组在住院时间上的差异无统计学意义。 (3)在5个研究中有3个试验提取到腹腔镜和显微外科治疗精索静脉曲张手术时间的相关数据,经RevMan5.1软件统计分析合并数据后得WMD=40.31,95%CI=(37.77,42.86),P0.00001,Z=31.03,认为在手术时间这个指标上腹腔镜手术治疗精索静脉曲张时要比显微外科手术短。 (4)在5个研究中有3个试验提取到腹腔镜和显微外科治疗精索静脉曲张术后鞘膜积液发生率的相关数据,经RevMan5.1软件统计分析合并数据后得WMD=0.05,95%CI=(0.01,0.27),P=0.0005,Z=3.49,认为在术后鞘膜积液发生率上显微外科治疗精索静脉曲张时比腹腔镜少。 (5)在5个研究中有3个试验提取到腹腔镜和显微外科治疗精索静脉曲张术后复发率的相关数据,经RevMan5.1软件统计分析合并数据后得WMD=0.10,95%CI=(0.04,0.25),P0.00001,Z=5.01,认为在术后复发率上显微外科治疗精索静脉曲张时比腹腔镜少。结论以上结果表明：显微外科和腹腔镜两种术式在治疗精索静脉曲张的术后精子数量提高和住院时间两种指标上没有显著差异。而在术后鞘膜积液发生率和术后复发率两个指标上显微外科要优于腹腔镜手术。在手术时间这个指标上腹腔镜要短于显微外科。但由于存在发表偏倚、选择偏倚的可能,我们期待出现更高质量的研究为以上结论提供更为可靠的证据。
[Abstract]:Purpose. To evaluate the efficacy and safety of laparoscopy and microsurgery in the treatment of varicocele, and to provide evidence-based basis for clinicians to select safe and effective procedures. Method. With the combination of electronic and manual retrieval, the related documents are first checked. The databases for electronic retrieval are Pubmed/Medline database, 1995.1-2012.10) OVIDE (1995-2012.10) EMBASE, China Biomedical Database (CBM), China Journal Full-text Database, CNKI: 1995.1-2012.10, China Evidence-based Medicine / Cochrane Central Database, CEBM\ CCDCDCCD-Cochrane Library; handheld search for the latest published relevant journal literature. And through all kinds of mainstream search engines to find and study the relevant literature. Collect all the relevant research literature about the surgical treatment of varicocele, and it is a randomized controlled trial (RCTs). The full text of the selected documents was obtained and the bias risk assessment tool recommended by Cochrane Cooperative Network was used to evaluate the experiment. The literature data were extracted by two researchers independently and the Meta analysis was carried out by RevMan5.1 software. Results. After primary selection and exclusion, 5 RCTs met the inclusion criteria and the total number of cases was 554. Meta-analysis showed that:. In 3 of the five studies, data on the increase in sperm count after laparoscopic and microsurgical treatment of varicocele were obtained. After the statistical analysis of the combined data by RevMan5.1 software, we found that the operation time of laparoscopic surgery for varicocele was shorter than that for microsurgery. (2) in 3 of the 5 studies, the data of hospitalization time of varicocele treated by laparoscopy and microsurgery were extracted. The data were analyzed by RevMan5.1 software and the data were analyzed. The results showed that there was no significant difference between the two groups in terms of hospitalization time. In 3 of the five studies, data were extracted on the operative time of laparoscopic and microsurgical treatment of varicocele. After the statistical analysis of the combined data by RevMan5.1 software, we found that the value of WMD-40.31 ~ 95CII was 37.77-42.86P0.00001 ~ (31.03). It was concluded that the operative time of laparoscopic surgery for varicocele was shorter than that for microsurgical treatment of varicocele. Data on the incidence of hydrocele after varicocele treatment by laparoscopy and microsurgery were obtained in 3 of the 5 studies. After the statistical analysis of the combined data by RevMan5.1 software, it was found that the incidence of postoperative hydrocele in microsurgical treatment of varicocele was less than that of laparoscopy. Data on recurrence rate of varicocele treated by laparoscopy and microsurgery were obtained in 3 of the 5 studies. Based on the statistical analysis of the combined data by RevMan5.1 software, it was found that the microsurgical treatment of varicocele in microsurgery was less than that in laparoscopy. Conclusion. The results showed that there was no significant difference between microsurgery and laparoscopy in the improvement of sperm count and the length of stay in the treatment of varicocele, but the incidence of hydrocele and postoperative recovery were not significantly different between microsurgery and laparoscopy. Microsurgery is superior to laparoscopic surgery in two indicators of incidence. In terms of operating time, laparoscopy is shorter than microsurgery. But due to publication bias, With the possibility of bias, we expect higher quality research to provide more reliable evidence for these findings.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R697.24

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